Self Guided Lumbar Puncture Training

Hardware Setup

Equipment list

• Laptop computer (with charger)
• Ascension trakStar tracker (with power cable + USB cable)
• Ascension EM field generator
• 1 Ascension model 800 sensor
• 1 Ascension tracked needle
• Lumbar spine models + phantom

Setup

1. Plug in Ascension tracker into laptop.
2. Plug in Ascension field generator in Ascension tracker.
3. Plug in Ascension sensors into the following ports: 0: Reference, 1: Needle.
4. Plug Reference sensor into lumbar spine model + phantom.
5. Turn on Ascension tracker and laptop.

Software Setup

Install CouchDB

1. Download and install CouchDB 2.1.1.

Install WinSCP (optional)

1. Download and install WinSCP.
2. Create a new WinSCP session called perktutorcouchdb, storing your username, password, and the default remote directory where you want to upload files to.

Install Slicer

1. Git clone the LumbarTutor repository to your computer, and check out the self-guided branch.
2. Git clone the PerkTutorCouchDB repository to your computer.
3. Download and install Slicer (latest stable version).
4. Install SlicerIGT, Sequences, Perk Tutor extensions from the extension manager.
5. Add the LumbarTutor and PerkTutorCouchDB paths to Slicer's additional module paths.

Install PLUS

1. Download and install PLUS (latest stable version).

Create Group Assignments

1. Add users who will train with 3D guidance to the Guidance.txt file, and user who will train without 3D guidance to the NoGuidance.txt folder. These files are located in the LumbarTutor resources directory in the UserGroups folder.

Create Spine Models

1. Create a scene in Slicer with the spine model, tissue model, ReferenceToRAS transform, and spine CT.
2. Save these nodes to file.
3. Copy and unzip an existing spine scene, and replace the saved nodes with your new saved nodes.
4. Update the scene name and node names, as applicable.
5. Rezip the spine scene.

Start Slicer & PLUS

1. Start the Plus Server, and select the Ascension 3DG configuration file in the Config folder.
2. Start Slicer, and navigate to the LumbarTutor module.
3. Launch the LumbarTutor module.

Calibrate Needle

1. Perform the needle calibration in Slicer, to compute the NeedleTipToNeedle transform.
2. Copy the transform into the Slicer.ini file located in the AppData folder, under the LumbarTutor section.

Changing Spine Models

Hardware Setup

1. Unplug the sensor from the old spine model.
2. Plug the sensor into the new spine model, ensuring correct sensor placement and orientation.
3. Replace the old spine model with the new spine model into the torso phantom.

Software Setup

1. Add the relevant spine model to the LumbarTutor resources directory in the SpineScenes folder.
2. Delete all irrelevant spine models.

Running a Session

1. Ask the user to login with their assigned UserID.
2. Have the user click "Start Recording" just prior to each practice attempt, and "Stop Recording" when they have finished each practice attempt.
3. Ask the user to logout when finished.

Troubleshooting

Running LumbarTutor without WinSCP

In some circumstances, no file server is available (e.g. no internet access in hospital) or WinSCP cannot be installed (e.g. on Mac/Linux). In these cases, LumbarTutor can still run, but files will not be transferred to the file server. Files must be transferred manually.

Syncing CouchDB

In some circumstances, CouchDB may not be able to sync with the remote server (e.g. no internet access in hospital). CouchDB will automatically sync with the remote server whenever the connection becomes available.

Interrupting a Session

Sometimes the trainee's session may be interrupted. Ask trainees to logout prior to leaving - this will save their incomplete practice attempt.

Uploading to the PerkData Server

In the PerkLab, we have a folder on the perkdata server where data can be stored. It is located at: /home/shared/data/PerkTutor/PerkTutorCouchDB. You may select this folder as your default session remote directory.